Predictors of procedural complications in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.

BACKGROUND: Balloon pulmonary angioplasty (BPA) is an effective treatment for inoperable chronic thromboembolic pulmonary hypertension, with good results reported for residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). However, BPA is associated with complications, such as pulmonary artery perforation and vascular injury, which can lead to critical pulmonary hemorrhage requiring embolization and mechanical ventilation. Furthermore, the risk factors for occurrence of complications in BPA are unclear; therefore, this study aimed to evaluate predictors of procedural complications in BPA. METHODS: In this retrospective study, we collected clinical data (patient characteristics, details of medical therapy, hemodynamic parameters, and details of the BPA procedure) from 321 consecutive sessions involving 81 patients who underwent BPA. Procedural complications were evaluated as endpoints. RESULTS: BPA for residual PH after PEA was performed in 141 sessions (43.9 %), which involved 37 patients. Procedural complications were observed in 79 sessions (24.6 %), including severe pulmonary hemorrhage requiring embolization in 29 sessions (9.0 % of all sessions). No patients experienced severe complications requiring intubation with mechanical ventilation or extracorporeal membrane oxygenation. Age ≥ 75 years and mean pulmonary artery pressure ≥ 30 mmHg were independent predictors of procedural complications. Residual PH after PEA was a significant predictor of severe pulmonary hemorrhage requiring embolization (adjusted odds ratio, 3.048; 95 % confidence interval, 1.042-8.914, p = 0.042). CONCLUSIONS: Older age, high pulmonary artery pressure, and residual PH after PEA increase the risk of severe pulmonary hemorrhage requiring embolization in BPA.

Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy.

BACKGROUND: Pulmonary endarterectomy (PEA) is the standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH), although some patients may experience residual pulmonary hypertension (PH). It is unclear whether balloon pulmonary angioplasty (BPA) is effective for residual PH after PEA. This study aimed to compare the BPA outcomes between patients with residual PH after PEA and those with inoperable CTEPH. METHODS: This retrospective study compared BPA for residual PH after PEA (25 patients, 101 BPA sessions) and BPA alone for inoperable CTEPH (21 patients, 89 BPA sessions). All patients underwent right heart catheterisation and functional and laboratory tests before PEA or before and after BPA. RESULTS: There was no difference in the number of BPA sessions per patient (4.0 ± 1.9 vs. 4.2 ± 1.9, p = 0.671). No significant differences were observed with respect to the mean pulmonary artery pressure (23.6 ± 9.1 vs. 21.9 ± 5.7 mmHg, p = 0.44), pulmonary vascular resistance (3.7 ± 0.5 vs. 2.8 ± 1.2 Wood units, p = 0.14), 6-min walking distance (392.1 ± 117.7 vs. 452.4 ± 90.1 m, p = 0.096), and World Health Organization functional class (I/II/III/IV: 14/11/0/0 vs. 9/12/0/0, p = 0.375). Severe haemoptysis requiring embolisation was more common in the PH after PEA group (16.0% vs. 5.4%, p = 0.018). However, no patients required mechanical ventilation or extracorporeal membrane oxygenation, and there were no procedural deaths. CONCLUSION: Although BPA might be effective for residual PH after PEA, it was associated with a high rate of haemoptysis.

Seven-year clinical outcomes of patients with moderate coronary artery stenosis after deferral of revascularization based on gray-zone fractional flow reserve.

The range (0.75-0.80) of fractional flow reserve (FFR) is known as the gray zone. Although the FFR of 0.80 was recently adopted as the cutoff value for coronary revascularization, the long-term clinical outcomes of patients with angiographically moderate coronary artery stenosis (FFR: 0.75-0.80) remain unknown. The objective of the present study was to investigate the clinical outcomes of patients with angiographically moderate coronary artery stenosis, whose FFR was 0.75-0.80. One hundred and twenty consecutive patients, for whom coronary revascularization was deferred based on FFR, were categorized to groups I and II, in which 55 and 65 patients had FFRs of 0.75-0.80 and 0.81-0.85, respectively. Adverse cardiac events included all-cause death, cardiac death, myocardial infarction, coronary revascularization for the FFR-measured and -unmeasured arteries, congestive heart failure, and admission for chest symptoms. Patients were followed up for 7 years after coronary angiography. Event-free survival rates of all adverse cardiac events were 73 % in group I and 63 % in group II (P = 0.35) and those of adverse cardiac events related to the FFR-measured artery were 94 and 85 % (P = 0.08). Throughout the follow-up period, the medication rate of statins was significantly lower in group II than in group I (P = 0.008). Seven-year clinical outcomes of patients with the gray-zone FFR were good. Furthermore, FFR-measured artery-related events in patients with the gray-zone FFR tended to occur less frequently than in patients with better FFR of 0.81-0.85. Optimal medical therapy is required for them, regardless of coronary stenosis severity and FFR.